应用不同手术方式在保胆取石术中的临床研究

目的:探讨完全腹腔镜、腹腔镜辅助胆道镜、及开腹保胆取石术的优缺点和手术技巧。方法:同一术者施术,完全腹腔镜保胆取石术34例,腹腔镜辅助胆道镜保胆取石术38例,开腹保胆取石术48例,对比分析其况。结果:120例患者均顺利完成手术,并取净结石。开腹保胆取石术手术时间明显少于完全腹腔镜、腹腔镜辅助胆道镜组,差异有统计学意义(P<0.05);但出血量及术后肠蠕动恢复时间、住院时间明显多于完全腹腔镜、腹腔镜辅助胆道镜组,差异有统计学意义(P<0.05)。腹腔镜辅助胆道镜组平均手术时间及术中出血量少于完全腹腔镜组(P<0.05);完全腹腔镜、腹腔镜辅助胆道镜组在术后肠蠕动恢复时间、住院时间方面差异无统计学意义(P>0.05)。完全腹腔镜、腹腔镜辅助胆道镜组术后均无并发症发生。开腹组术后随访出现8例并发症,其中4例伤口感染、3例胆汁漏、1例盆腔积液。三组随访3~18个月,未发现结石复发。结论:全腹腔镜和腹腔镜辅助胆道镜保胆取石术是安全可行的,具有创伤少、术中出血少等优点,尤其是腹腔镜辅助胆道镜保胆取石术,可以在直视下进行,术后结石复发率低。开腹保胆术时间相对较快,对患者身体素质偏差者能迅速结束手术,但并发症多,尽可能不选用。

Different operation mode application and clinical study of stone in gallbladder preserving operation

Objective The advantages and disadvantages and operation skill of laparoscopic,laparoscopic assisted choledochoscopy,and opencholecystotomy.Methods By the same surgeon operation,34 cases of laparoscopic gallbladder preservingcholelithotomy,laparosco pic assisted Choledochoscope for preservation of gallbladder in 38 cases ureterolithotomy,48 cases laparoscopic gallbladder preserving cholelithotomy,comparative analysis of the situation.Results 120 patients were successfully completed the operation,and take net calculi.Open preserving cholelithotomy operation time was less than completelaparoscopy,laparoscopic assisted choledochoscopy group,the difference was statistically significant（P〈0.05）;however,the amount of bleeding and the recovery time of intestinal peristalsis,the hospitalization time was significantly more than that in laparoscopic,laparoscopic assisted choledochoscopygroup,the difference was statistically significant（P〈0.05）. Laparoscopic assisted choledochoscopy group average operation time and bleeding amount less than totally laparoscopic group（P〈0.05）;laparos copic,laparoscopic assisted choledochoscopy in the recovery time of intestinal peristalsis,the hospitalization time was not statistically significant differences（P〉0.05）.Totally laparoscopic,laparoscopic assisted choledochoscopy groupwithout postoperative complications.Complications occurred in 8 patients in laparotomy group were followed up after operation,including 4 cases of wound infection,3 cases of bile leakage,1 cases of pelvic cavity effusion.Three patients were followed up for 3-18 months,no stone recurrence.Conclusion Total laparoscopic and laparoscopic assisted cholangioscopic cholecystolithotomy is safe and effective,with less trauma,less bleeding and other advantages,especially laparoscopic assisted choledochoscopy cholecystolithotomy,can be carried out in the open,low recurrence rate after operation.Laparoscopic gallbladder preserving operation time relatively quickly,the end of operation on patients with ra